title: Bone to total alkaline phosphatase ratios improve sensitivity and specificity of bone alkaline phosphatase immunoassays.
abstract: OBJECTIVE
  Evaluate the ability of two bone alkaline phosphatase (ALPB) immunoassays (Ostase, Hybritech Inc and Alkphase-B, Metra Biosystems) to clinically differentiate between osseous and non-osseous ALP sources.
  
  
  METHODS
  Specimens from patients with either liver or bone disease (Paget's disease or metastatic cancer) were analyzed by both methods.
  
  
  RESULTS
  There was a good correlation between these two assays. Values for ALPB, whether determined as a concentration by the Ostase assay or as an activity by the Alkphase-B assay, were similar for subjects with liver disease or bone disease. However, total ALP (ALPT) activity was higher in liver disease compared to bone. When ALPB was expressed in relation to ALPT, ratios were significantly greater in subjects with bone disease than in those with liver disease. ALPB/ALPT ratios improved the specificity of the Ostase assay from 52% to 86% and the Alkphase-B assay from 58% to 74%.
  
  
  CONCLUSIONS
  These two ALPB assays have good analytical performance and their clinical utility can be enhanced by expressing ALPB values in relation to ALPT activity.
authors.affiliation: Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. lsokoll@welchlink.welch.jhu.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Sokoll
authors.forename: M H
authors.initials: MH
authors.lastname: Kroll
authors.forename: M A
authors.initials: MA
authors.lastname: Levine
authors.forename: F F
authors.initials: FF
authors.lastname: Poordad
authors.forename: D W
authors.initials: DW
authors.lastname: Chan
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism*; D001847:Bone Diseases / Q000201:enzymology; D001842:Bone and Bones / Q000201:enzymology*; D005260:Female; D006801:Humans; D007118:Immunoassay; D016014:Linear Models; D008107:Liver Diseases / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D000469:Alkaline Phosphatase